Edema Of The Ankles/Lower Legs

What Causes Swollen Legs Or Ankles?

Swollen legs or ankles can have various causes, ranging in severity from 'troubling' to 'generally fatal'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose swollen legs or ankles, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "swollen legs or ankles" as a symptom.  Here are eight of many possibilities (more below):
  • PMS H
  • Thrombophlebitis
  • Alcohol Consequences
  • Protein Deficiency
  • Atrophic Gastritis
  • Congestive Heart Failure
  • Hormone Imbalance
  • Kidney Disease

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
very great unexplained weight loss
frequent nighttime urination
pain medication use
regular unexplained nausea
macrocytic red cells
severe fatigue after slight exertion
stabbing epigastric pain after meals
painful urination
edema of the feet
late puberty onset
weak appetite
a very enlarged nose
... and more than 60 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of swollen legs or ankles:
Cause Probability Status
Congestive Heart Failure 94% Confirm
Hormone Imbalance 23% Unlikely
Protein Deficiency 20% Unlikely
Thrombophlebitis 1% Ruled out
PMS H 0% Ruled out
Alcohol Consequences 0% Ruled out
Kidney Disease 0% Ruled out
Atrophic Gastritis 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate edema, The Analyst™ will ask further questions including this one:
Do you have edema of the ankles or lower legs? To rate its severity, press firmly with a finger for 5 seconds and note the approximate depth of the indentation or length of time to return to normal.
Possible responses:
→ No / don't know
→ Slight: 5mm (1/4 inch) depth, immediate return
→ Minor: 8-10mm (1/2 inch) depth, 10-15 seconds
→ Moderate: 11-20mm (3/4 inch) depth, 15-30 seconds
→ Severe: Over 20mm (1 inch) depth, over 30 seconds
Based on your response to this question, which may indicate edema of the ankles/lower legs, The Analyst™ will consider possibilities such as:
Cirrhosis of the Liver

When the liver loses its ability to make the protein albumin, water accumulates in the legs and abdomen.

Congestive Heart Failure

Edema of the ankles is a common manifestation of failure of the right ventricle related to both venous congestion and salt and water retention.  Those experiencing constant or worsening swelling of the feet or legs should see a doctor for a heart evaluation.

Edema (Water Retention)

Edema (Water Retention) also suggests the following possibilities:

Alcohol-related Problems

Excessive alcohol intake can cause edema.

Anorexia / Starvation Tendency

Semi-starvation can cause edema.  People with eating disorders may interpret the puffiness of edema or any changes on the scale as weight gain or getting "fat" and may panic and purge or take laxatives even more.

Aspartame/Neotame Side-Effects

Angioedema or swelling of the eyelids, lips, hands or feet are listed as possible reactions to aspartame.

Atrophic Gastritis

Edema may be due to low levels of circulating proteins from poor protein digestion.

Excess Salt Consumption

Salt can increase the amount of fluid that you retain in your body.

Progesterone Low or Estrogen Dominance

Progesterone has been used in the treatment of idiopathic edema under the premise that some women with idiopathic edema either do not ovulate or have a luteal phase deficiency.

Ovarian function was investigated in 30 women with postural idiopathic edema by measuring plasma estradiol and progesterone levels between the 21st and 23rd days of the menstrual cycle.  Plasma progesterone concentrations were found to be lower than 5ng/ml in 53% of the cases and lower than 10ng/ml in 83%.  The ovarian dysfunction most frequently observed was inadequate corpus luteum, i.e. progesterone deficiency with normal plasma estradiol levels.  In virtually all patients the initial disorder in capillary permeability, as evaluated by Landis' test, was fully corrected by progesterone administered orally.  However, clinical improvement was less marked with treatments of short duration (2-3 consecutive cycles).  In view of the complex cause of the disease, combined treatments in which progesterone might well play the major role are usually required. [Presse Med 1983 Dec 10;12(45): pp.2859-62 (translated)]

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